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General NPI Number Information
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NPI Number | 1013511229
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Entity Type | Organization
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Legal Business Name | NATURAL LIFE WELLNESS LLC
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Dates
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Enumeration Date | 11/28/2020
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Last Update Date | 11/28/2020
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Provider Practice Location Address
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Address Line | 56 WAKELEE AVENUE EXT APT 56
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City | SHELTON
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State | CT
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Zip | 06484-3964
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Country | US
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Telephone | 631-357-9949
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Fax | 475-252-8417
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Provider Business Mailing Address
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Address Line | 56 WAKELEE AVENUE EXT APT 56
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City | SHELTON
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State | CT
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Zip | 06484-3964
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Country | US
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Telephone | 631-357-9949
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Fax | 475-252-8417
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Authorized Official
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Title or Position | OWNER
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Name | DR. ZOE HICKSON
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Credential | ND
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Telephone | 631-357-9949
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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